The Feasibility, Cost-Effectiveness and Mechanisms of Action of Prehabilitation for Patients Undergoing Major Cancer Surgery in Remote and Coastal Communities.
Ross Armstrong (UoC), Chris Rao (NCIC), and Natasha Richardson (NCIC)
Cancer treatment can be physically and emotionally demanding, particularly when major surgery is required. Increasingly, research has shown that preparing patients before treatment can make a real difference; through exercise, nutrition, and psychological support; a process known as “prehabilitation”. Patients who take part in prehabilitation are often fitter going into surgery, recover more quickly, and experience fewer complications. Yet despite this evidence, prehabilitation is not routinely available across the NHS, and access is especially limited in rural and coastal areas such as Cumbria, where cancer outcomes are consistently poorer than the national average.
This programme of work, supported by both the PCSM Research Hub Project Grant and a dedicated PhD fellowship, aims to change that. Together, they will establish and rigorously evaluate a new community-based prehabilitation service for patients with colorectal cancer in North Cumbria. By embedding prehabilitation into local treatment pathways and delivering it through community venues, the project will test whether the benefits seen in large specialist hospitals can be replicated in underserved regions. Patients will be offered tailored support ranging from self-directed advice to fully supervised exercise programmes, alongside nutritional guidance and psychological care. Their experiences, as well as those of clinicians, will be captured to ensure the service is practical, acceptable, and sustainable.
At the same time, the research will go deeper, exploring not only whether prehabilitation works, but how it works. Alongside traditional measures such as hospital stay, complication rates, and quality of life, the project will investigate the biological effects of exercise on cancer. By collecting fitness data, patient-reported outcomes, and biological samples, the study will examine how physical activity influences inflammation, immune function, and even tumour biology. This will help to uncover the mechanisms that underpin the benefits of prehabilitation, guiding the design of future programmes.
Crucially, the project will also assess cost-effectiveness, modelling the impact of different delivery strategies on NHS resources and patient finances. Demonstrating that prehabilitation not only improves outcomes but also represents good value for money will be key to securing long-term funding and embedding it as a standard part of cancer care. Patients themselves are central to the work: they have helped shape the design of the service, will act as co-investigators on the steering group, and will play a role in interpreting and sharing the findings.
By combining service innovation, patient partnership, health economics, and cutting-edge biological research, this programme has the potential to transform cancer care in Cumbria and beyond. It will provide a blueprint for delivering high-quality prehabilitation in rural and underserved areas, reduce inequalities in access to supportive care, and ensure that every patient has the best possible chance of recovery and long-term health.